Journal of Pediatric Care

Long term outcomes following baked milk-containing diet for IgE-mediated milk allergy

EuroSciCon Conference on Pediatrics 2017
November 13-14, 2017 London, UK

Ilan Dalal, Jenny Weinbrand Goichberg, Shira Benor, Menahem Rottem, Nitzan Shacham, Avigdor Mandelberg, Arie Levine, Koby Sade and Shmuel Kivity

Wolfson Medical Center, Israel Tel Aviv Sourasky Medical Center Haemek Medical Center, Israel Sackler faculty of medicine - Tel Aviv University, Israel

Posters & Accepted Abstracts: J Pediatr Care

DOI: 10.21767/2471-805X-C1-003

Abstract

Background: There is limited knowledge regarding long term follow-up of milk allergic patients who tolerate baked milk (BM) products. Objective: The objective of the study is to evaluate the longterm safety and efficacy of this intervention. Patients & Methods: Children with IgE-mediated milk allergy underwent an oral challenge with BM. Those who tolerated BM underwent baked cheese pizza (BC) challenge after 6 months. Six months later, a challenge with unheated milk was offered to patients who tolerated BC. Results: 85 children (median 5.2 years; range 15 months to 15 years) were prospectively followed for a median of 29 months (range 15-50 months). Fifteen (18%) reacted to the initial BM challenge. Reactions were mild in most cases and only 3 had anaphylaxis. Among 70 (82%) children who initially tolerated BM challenge, 26 (37%) tolerated unheated milk at last follow up, 16 (23%) tolerated BM/BC and 25 (36%) avoided all forms of milk despite successful initial BM/BC challenges. Another 3 patients (4%) were lost to follow-up. Predictive parameters of reactivity to initial BM challenge include age (median - 7; range 2.5-15 years vs. 3.5; range 1-14.5 years; P= 0.02), mild respiratory symptoms (67% vs. 26%, P<0.01) as part of the reported allergic reaction to milk, asthma (53% vs. 14.3%, P< 0.01) and a larger SPT to casein (median 14; range 8-28 mm vs. 6; range 0-18 mm; P<0.01) Conclusions: For most of our patients, ingestion of BM was found to be safe and well tolerated. However, initial successful challenge with BM/BC does not always guarantee ongoing consumption of these products. Better predictors of response are needed for patient selection and long-term outcomes.